Background: Individual Placement and Support (IPS) is an effective, evidence-based intervention to support transition to paid work for individuals who have a serious mental illness. Currently, there is a lack of qualitative reporting from the people receiving IPS and their support networks. Approach: A case study of a 42-year-old-man who has schizophrenia and who attends a community mental health team in a Canadian urban centre is presented. His experience and that of his mother, employer, and clinical supports are shared through semi-structured interviews. The authors of this paper include a peer researcher who has been a participant in an IPS program. Findings: The enduring and individual support of IPS is credited with being central to the study subject's successful acquisition and maintenance of paid employment. His involvement in paid work is also associated with improved health outcomes, including a significant reduction in the frequency of medical appointments to monitor his mental health. Improved social skills and self-efficacy are also reported. Conclusion: Provision of IPS services within a multidisciplinary mental health team can promote the acquisition of durable employment for individuals in recovery from serious mental illness. Clinicians are reminded to check their assumptions regarding which individuals could benefit from IPS, and are encouraged to take their lead from clients in determining whether to commence or continue employment services.
Therapeutic time is a relatively new, ward-based intervention whereby psychiatric nurses spend regular, uninterrupted periods of time with patients during which they do not attend to other matters. A questionnaire survey of nursing and medical staff was conducted to assess attitudes to the approach. The majority of staff viewed the approach as being important for promoting patient recovery, reducing risk, improving nurse-patient relationships and enhancing patient satisfaction with care received. Interference with medical activities, lack of staffing resources and variable patient uptake were highlighted as potential problems. More research is required to establish the benefits, drawbacks and nature of therapeutic time. Given the current support for the approach and previous research emphasizing the extent to which patients value protected time to speak to nurses, investment of resources in further exploration and implementation of this approach may lead to significant clinical returns.
This case report describes the transformation of a sheltered workshop program to a program that provides evidence-based supported employment services in partnership with five community treatment teams. Over a 15-year period, a Canadian nonprofit agency that provides employment services for persons with severe mental illness made a series of programmatic changes to increase the effectiveness of the services. The agency initially modified its facility-based sheltered workshop to include a prevocationally oriented work preparation program, later added brokered supported employment services, and finally completely transformed its organization by relocating its vocational rehabilitation counselors to five community mental health teams, in order to implement an evidence-based supported employment program that is based on the individual placement and support model. During the initial period in which the sheltered employment program was utilized, less than 5 percent of clients who were unemployed when they entered the workshop achieved competitive employment annually. The annual competitive employment rate did not increase during the prevocational phase; it increased during the brokered supported employment phase but did not exceed 25 percent. By contrast, after shifting to evidence-based supported employment, 84 (50 percent) of 168 unemployed clients who received between six and 27 months of individual placement and support services achieved competitive employment. This article also documents the role of agency planning and commitment quality improvement in implementing change.
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